Student Matt Addis has spent much of his four years at the Virginia Tech Carilion School of Medicine researching how pulmonary function tests are administered to patients. What he discovered might pave the way to more-effective diagnosis and treatment protocols for illnesses that cost the United States billions of dollars each year.
Pulmonary function tests (PFTs) for such conditions as asthma and chronic obstructive pulmonary disease (COPD) consist of three parts. Spirometry measures the velocity of air movement in the lungs. Lung volume measures how much air a patient can inhale. And diffusion capacity measures how well a patient’s lungs can exchange gasses, specifically carbon monoxide as a surrogate marker of oxygen diffusion.
Typically, patients are administered all three parts of the test and then given a bronchodilator, such as Albuterol. This treatment dilates the bronchi and bronchioles in the lungs, thus decreasing resistance and increasing airflow.
After a short waiting period, patients are then re-administered the spirometry portion of the test to determine if the medication made a difference in their lung function.
“Curiously, usually only the spirometry portion of the test is re-administered and not the other two parts,” Addis said. “We wanted to know if we were missing people who might otherwise benefit from bronchodilator therapy. Perhaps they fell through the crack because their repeat spirometry test didn’t show enough improvement to warrant the therapy, whereas if they had been administered all three parts on the repeat test, they might have shown improvement in one or both of the other two areas.”
Addis’s research consisted of adding the other two sections of the PFTs to the retest of more than 500 individuals at Carilion Clinic’s Pulmonary Function Lab so that they were given all three parts both before and after the bronchodilator.
This was no easy task. Addis spent countless hours in the pulmonary function lab personally recruiting patients to take part in the study.
“I learned how difficult patient recruitment can be,” he said. “It was harder than I expected. But with practice, I developed a recruitment strategy that had good results. After you do it about 200 times, you get pretty polished.”
Through trial and error, Addis found that the three most important things to tell a patient right away after briefly explaining the basic concept of the research were that the extra testing would take about 20 minutes, that it would be free of charge, and that the results were confidential.
“With his welcoming personality, Matt built a good relationship with our patients and respiratory technicians, who administer the pulmonary function tests,” said Edmundo Rubio, section chief for Carilion Clinic’s pulmonary and critical care medicine and Addis’s research mentor. “There is no question that his efforts facilitated increased patient recruitment.”
A total of 543 patients were recruited for the study, netting 444 valid results.
In the end, what Addis and Rubio found was that overall there were statistically significant improvements in all three of the lung function areas in the patients who took part in the study. Breaking the total research population down into subgroups showed that some of the groups had statistically significant improvement and some didn’t.
Addis said a future research question will be to determine if there is a specific group of patients, such as those with COPD or those who are elderly, that are more likely to show improvements.
“In the future, this research might also include a survey to determine if patients who have these improvements in their lung volume and diffusion capacity scores actually feel better,” Addis said. “Hopefully, when we combine the survey and the PFT, we can determine if we’re seeing real objective improvement.”
Addis said data gathering will continue after he graduates in May, with the project being led by physician Tomer Pelleg, pulmonary and critical care fellow at Carilion Clinic.
“The idea is to develop a huge database of these patients and then really mine the data,” he said. “This project, if we found changes, which we did, was intended to be a stepping stone to a lot of other projects.”
Addis will present his findings in a poster session at the American Thoracic Society meeting in May and is working on a manuscript for submission to the organization’s professional journal.
Not bad for someone who came to the Virginia Tech Carilion School of Medicine with a degree in mechanical engineering. Addis was excited about the school’s emphasis on research and impressed by the opportunities available with such a small class size.
“I was concerned at the time that it was a newer school, so it was a bit of a leap of faith,” he said. “But I’ve been very happy here.”
This summer, Addis will begin his residency in emergency medicine. But a few important things must happen first, including his graduation from medical school on May 6 and his wedding to classmate Genevra Myers later in May.
Addis is one of eight students in this year’s graduating class of 40 who have been selected to present their work during the VTCSOM Medical Student Research Symposium on March 24. The event is from noon to 5 p.m. in room 203 at the school. Admission is free, and the public is invited to attend.